November 30, 2012

I love AngryBirds. Fire the
slingshot to send the single-minded birds on their mission! Victory comes when the evil pigs die! Getting
engaged in the game is so easy. On level
1-1, the player gets three angry birds to kill one evil pig in a wooden and ice
structure. Usually, the player needs
only one angry bird to succeed at the mission and feels like a “rock star”
after the victory. The story and
feelings build with each episode and level.1

But how do suicidal birds relate to healthcare and education? Think of the last time you
sat in a class and were captivated by the topic. Compare that to the last time you played a
video or computer game and were completely engrossed. In which
situation were you more engaged and involved?
I’ll admit, I often feel more involved when I play AngryBirds than when I listen
to a lecture.

So what exactly is a game? The definition seems to be evolving, but
Roger Caillois, the French sociologist, said that games have six elements: (1)
non-obligatory (2) separate in time and place (3) uncertain course (4)
unproductive (5) governed by rules and (6) make-believe.2 Games are designed with multiple ways of
keeping the player participating and involved.
Most presentations I have seen lack that level of engagement. The
lecture is thought by some to be an inefficient, stifling, and clunky means of
delivering instruction; a blunt tool in an age of laser precision.3

Why do games make a difference
now? Games are not new to healthcare education.
In 1995, one of my preceptors played
Jeopardy! during her pharmacy residency at the University of Illinois,
Chicago. But technology has improved
significantly since 1995. The
proliferation of mobile devices such as tablets and smart phone pave the
way for using these devices to teach.
These devices are the first to overcome the limitations of handsets as
learning tools.3 The technology also allows the speed and scope of information
to be more current than is typically seen in academic courses.4

How are games being used in
healthcare? Currently, there are more
than 300 health-related games on the market aimed at patients in two general
themes – physical exercise and brain fitness games.5 But disease-specific games are also available
such as Re-Mission, a video game for young people with cancer. The lead characters for Re-Mission include
Roxxi, a microscopic robot that fights infections and cancer at the cellular
level; Smitty, a retired nanobot who provides holographic guidance to Roxxi;
and Dr. West, creator of the self-aware artificial intelligence nanobots and
the nanotech chronic illness treatment program.6 From a patient education standpoint, the game
addresses the importance of taking oral chemotherapy regimens, prompt reporting
of symptoms and side effects, proper nutrition, as well as anxiety, nausea, and
pain management.7 A randomized controlled trial compared adolescents
and young adults who played a standard commercial video game versus
Re-Mission. Participants were asked to
play the game at least one hour per week for the three-month study period. The
conclusion of the trial is that treatment adherence and indicators of
cancer-related self-efficacy and knowledge were significantly improved in those
who played Re-Mission.8

Games are engaging. They can be used to teach by allowing the
learner to apply newfound knowledge to new situations. Game scenarios can be easily modified to
reflect the continuous influx of healthcare information updates. While playing the game, the learner has the
opportunity to make decisions and instantly see the results of those
decisions. The ability to recreate the
scenario allows the learner to practice this decision-making skill. Better
decisions in healthcare result in better healthcare.

November 28, 2012

The role of an educator, in the classroom and in practice, is to
foster learning and serve as a role model.
Role modeling can be defined as teaching by example and influencing
people in an oftentimes unintentional, unaware, informal, and episodic manner.1
Thus, we all serve as role models for learners in our field through our routine
actions. Role modeling has often been
referred to as the “hidden curriculum” of professional education as we often lack
understanding regarding the influence role modeling has on learners.1
Students learn behaviors that appear successful to them in light of their
personal goals and rewards. This is a foundational
principle of social learning theory and how role models exert influence on others.

In a study published in 1997, researchers at the McGill University
School of Medicine examined opinions of fourth year medical students using a
questionnaire.3 Ninety
percent of the responders identified one or more role models during their
training.3 Many (35%) indicated that resident physicians were the
most influential role models during the clinical portion of their academic
training.2 This finding demonstrates that pharmacy residents have a
profound effect on student pharmacists.
As pharmacy residents, we have frequent interactions with students. It may be easy to forget that we have an
obligation to be a positive model of pharmacy practice.

Several common factors were consistently ranked high when students
selected role models: personality, clinical skills and competence, teaching
abilities.2 Interestingly, position, academic rank, research
experience, and publications were less important.2 This finding
suggests that is it not just the well-established, published, infamous leaders
who are revered as models. Instead,
professionals of all age and rank may be influential.

Role models were not only important in helping students develop their
knowledge and skill but 57% of students claimed their role model influenced
their decision regarding their clinical specialty for residency training.2 Thus, the potential impact of a role model is
very significant and can shape and inspire a career.

While role models often influence learners in positive ways, it is
important to discuss the potential for a negative impact. In a study surveying students at the
University of Texas Medical Branch in Galveston, the professional behavior of
faculty and residents was examined.4
The authors found that the preceptors scored lowest on the following
behaviors: 1) use of constructive
criticism instead of backbiting about peers, and 2) consulting others when they
lack the required knowledge.4
Prior research noted that students find bad-mouthing
others as the most unprofessional behavior of faculty.4 Making
negative comments about a specialty may discourage or decrease recruitment into
that field.1 And, it might incite
pessimistic attitudes towards a learner’s chosen profession.1 As we are emerging leaders and role models
for future generations of pharmacists, we must hold ourselves to higher
standards. Negatively discussing
colleagues sets a poor standard for ourselves and may also encourage bad habits. In order to cultivate positive relationships
between disciplines, we must refrain from voicing negative personal opinions in
workplace conversations.

To become positive role models, we must understand how our behavior
affects others. “Silent modeling is inadequate
as a strategy.”1 Where do we begin? Role models must pay attention to their
individual acts, encourage teamwork, and support others in their growth and
development.5 Ideal role models inspire and teach by
example. The key is to be self-aware and
self-critical.6

In order to change our behavior, we need to have the desire to improve
and the insight to identify our strengths and weaknesses.6 Being
self-critical of our current positive and negative actions in the workplace,
allows us to develop personal improvement plans. Self-reflection has two forms:
“reflection-in-action,” thinking about changing the experience while it is
underway, and “reflection-on-action,” critically evaluating an experience once
it has passed.1 Both are valuable tools to encourage change, and
learner evaluations are a key source to identify areas of potential improvement. Encourage your learners to critically
evaluate you as a preceptor. Skills to
evaluate might include your ability to encourage teamwork and solve challenging
problems with composure. This may not be
on the standard evaluation form, but it is appropriate to ask learners to
evaluate you as a role model and as a source of clinical knowledge. As you achieve positive marks, add new
professional goals for learners to evaluate.
In this way, you have used your self-reflection and created a process to
evolve and grow as a model.

Learners must learn to “talk the talk, and walk the walk.”1
In this dynamic teaching method, role models talk through activities, explain their
thought process, and allow for learners to discuss their own ideas and methods.1
In this coaching method, students engage in the actions of their model, and
receive verbal feedback. For example, a
preceptor on rounds may have a student observe the first day to familiarize
with the experience. After rounds, this
preceptor can break down their thought process for recommendations by working
through a patient with their learner. In
the following days, students learn how to model the appropriate behavior by
presenting recommendations to both their preceptor and team, receiving feedback
and constructive comments all the while. We must set expectations. If we fail to set appropriate guidelines for
behavior, we have no basis for constructive criticism and students may feel
lost without guidance.

Think back to the people who had a positive influence on your
development and career choices. Let
their strengths serve as guide in your career.
When we become the person to be emulated, we have a profound effect on others.

November 21, 2012

by Jenna Klempay, Pharm.D., PGY1 Community Pharmacy Practice Resident,
University of Maryland School of Pharmacy

When teaching students how to
provide pharmaceutical care, pharmacy educators have emphasized providing
personalized, patient-centered care. It
is no longer acceptable to paternalistically tell patients how to take their
medications and manage their disease states.
Student pharmacists are being taught to listen to the patient and tailor
therapy to suit the patient’s lifestyle.
Evidence shows there is a positive correlation between patient-centered
communication and improvement in health outcomes.1 But given the subjective nature of the topic,
it can be challenging to teach “patient centeredness.” I believe pharmacy schools need to do a
better job teaching this concept and emphasizing it throughout the curriculum.

Explaining terms to students
like “empathy”, “compassionate care”, and “active listening” and role-playing
how to provide patient-centered care is a good start. But it’s not enough. In order to really open the eyes of the
student to the humanism of pharmaceutical care, the curriculum needs to include
reflective learning activities. One
pharmacy school has developed a course that utilizes reflective and discovery learning
to explore how pharmacists can improve interpersonal connections with their
patients and facilitate healing, both physically and mentally.1

The University of California-San
Francisco (UCSF) School of Pharmacy offers a one credit elective course titled,
The Healer’s Art. It is modeled after a course developed
for medical students taught by Dr. Rachel Remen of the UCSF School of
Medicine. The course is offered at
medical schools across the nation, but UCSF is the first pharmacy school to offer
it to student pharmacists.2

The course includes three major instructional methods:

Case studies shared by guest health care
practitioners

Student/faculty reflection in small groups

Journaling between sessions

The course includes five sessions covering different topics intended
to meet the course goal: understanding the “value of being ‘fully’ present and
attending with heart” to patients:2

Session 1:
“Tending to Our Patients” focuses on being fully present and
attentive to patients in an appreciative and non-judgmental way.2

Session 2: “Tending to Ourselves” challenges
the students to reflect on the importance of caring for oneself and having
a balance in life in order to offer “mindful, heart-based work”.2

Session 3:
“Tending to Life Changes” reflects on physical, mental, and
emotional effects of life and how being present and listening with heart
can be meaningful in healing.2

Session 4:
“Tending to Appreciation and Alignment” offers an opportunity to
recognize the joy of the profession in giving to others and also serves as
a reminder of the impact pharmacists can have on the well-being of their
patients.2

Session 5:
“Translating Heart Matters into Practice” allows students to
reflect on their experience and recognize the value of creating “safe
places” for patients when developing a pharmacist-patient connection.2

Students are evaluated on their competency based on faculty
observations during small group sessions, a review of each student’s reflective
journal, and a questionnaire at the end of the course.

Students indicated that the course was a positive experience, they
learned how to listen ‘with heart’, and they felt more comfortable dealing with
emotional situations. In addition, this
class enriched their view of professional practice.2 Students felt empowered to “address the
emotional needs of patients and their families” and understood that emotional
needs can contribute to and complicate a patient’s condition.2 This class is an excellent example of
how to teach students to be more patient centered and facilitate their growth
as professionals.

The key to providing patient-centered care is not merely recognizing
the illness, but also understanding the attitude or perception the patient and creating a way to provide care in a
manner that is conducive to healing.3 By teaching students from the beginning how to
provide this type of care, we can stop them from developing poor patient care habits. All too often, students are taught
by preceptors who have become cynical, burnt out, and accustomed to suppressing
their emotions and treating patients more like disease states than humans. It is important for educators to teach
students how to keep their hearts alive in settings where many lose heart. When students begin experiential learning,
they will encounter patients suffering and dying. Students need to be prepared to face these
realities and help patients, families, and caregivers. The pharmacy curriculum should teach humanism
just as much as it prepares students to be knowledgeable about pharmacotherapy.

Effectively teaching students to practice with their heartsrequires a different approach. Typical didactic teaching won’t work. Patient centeredness cannot be taught through
a series of lectures. It requires
reflection. Reflection is more likely to
lead to deeper learning and meaningful change.
Reflection can be prompted through stories about one’s experiences,
journaling, and small groups discussions.
Students should be encouraged to express their feelings. This can only be fostered by creating a safe classroom
environment where students feel comfortable opening up and sharing personal
thoughts. The classroom environment
should emulate the type of environment the student should one day create for
his or her patients. Finally, an affirmation
activity during the last class session will facilitate the transfer of the
classroom experience to the clinical setting.
An affirmation activity consists of each individual sharing positive
remarks about how the student can make a difference in the lives of
patients. This activity will give
students confidence in their ability to care compassionately for patients and
encourage them to take what they have learned into practice.

UCSF provides a great model for how to teach a topic that is not easy
to teach. While this class is a great
start, a one-credit course is not enough.
If we want to mold our students into patient-centered practitioners,
this kind of reflective learning should occur during all four years of pharmacy
school. Yes, the curriculum is already
crammed full, but one potential solution is to hold a yearly class retreat for
students to revisit important concepts of humanism. Clinical faculty and preceptors should be
invited to this retreat to renew their hearts and reaffirm the qualities that
make them caring practitioners. Since
these pharmacists are mentors and role models for students, it is important
that they model for students patient centeredness in their words and actions.

Dan Pink, keynote speaker of the 2007 AACP Annual Meeting, advised
pharmacy educators to “challenge students to mature into holistically oriented
healers, knowledgeable about the whole person with whom they soon will be
establishing healing relationships.”4
Students need to be taught that the pharmacist-patient interaction
is just as important as the technical services and the medications we provide. Medications are not enough. By providing compassionate care, we have the
ability to heal with our hearts as well.

November 18, 2012

by Roshni Patel, Pharm.D., PGY2 Ambulatory Care
Pharmacy Resident, University of Maryland School of Pharmacy

Let me
use this musing to tell you about what’s right with people. And why we should pay more attention to
people’s strengths and less to perceived weaknesses.

As
educators, we look to employ new and creative instructional strategies to help
strengthen the weaknesses of our students to ensure competence. The feedback and evaluations that we provide
our students are typically aimed at addressing students’ deficits. But perhaps we have it all backwards. If we utilize all of our time developing
weaknesses, what happens to the innate strengths that students possess? Is there a possibility that if they don’t
‘use it’ they’ll ‘lose it’ as we claim applies to so many of our skills? I think so.

Tom Rath
is leading business consultant on Wall Street and one of the best selling
authors over the last decade. He has
drawn attention to our fundamental weakness (no
pun intended) for focusing so much of our time and energy on shortcomings rather
than capitalizing on strengths.1
In his book Strengths Finder 2.0
he encourages readers to redirect attention toward what they do well, which he
believes is the key to a greater well being. Specifically, he believes that not
enough people have the opportunity to do what they do best at work each day. But
they can…

This
notion that Rath discusses within the context of business is relevant to the world
of academia too. In fact, paying greater
attention to our strengths easily integrates with core educational
theories. For example, one of the
guiding principles of constructivism is the search to understand the world in
which we live in. Within this theory of
learning, students are encouraged to interpret and judge their own progress as
they take ownership of their learning experience. If we devote time to helping students to
first understand their talents, they can then invest in those skills. Rath argues that raw talent needs to be
cultivated, and the student aware of his or her talents will be fully engaged,
challenged, and interested in their own application of their strengths
to their experiences.

What
about behaviorism? Is an emphasis on
strengths compatible with this theory? We
tend to reward our students when we recognize improvements in their behaviors,
and there is tons of empirical data to show that we can train people to produce
a specific response. But why not change
the stimulus? Lets reward our students
for recognizing their talents and condition the learners to respond
appropriately to their own strengths.
Rath’s book does just that. In
addition to identifying the readers’ strengths, the book supplies ideas for
action that help readers apply their strengths to every day living and
practice.

Critics
of Strengths Finder 2.0 argue that
it’s just another personality questionnaire, but I strongly disagree. The raw personality of Bill Clinton does not
show his strengths. And, his strengths
are not equivalent to his personality. I
also believe that so many of us do not truly know our strengths. Sure, we all ramble off a laundry list of
so-called strengths during professional interviews – ones we have written down
and memorized, ones we feel will win us the job.

Let me
be clear. I am not promoting the absolute disregard of evaluating our
weaknesses. There is clear benefit in recognizing the skills we lack (and need). And we should try to improve weakness that make less effective. But what I’m
recommending is a redistribution of our time and attention. If we agree with David Kolb that individuals
learn in different ways, then we have to acknowledge the baseline
characteristics of our learners.2
And that should include their strengths.
If we understood
the intrinsic strength of our learners better, we could facilitate learning
experiences around their talents. Ultimately,
I believe, this strategy will prevent creating people who are a jack-of-all-trades and a master
of none. If the students are aware of
their strengths, they can utilize their professional education to develop their
application of those strengths. Have I said it enough, yet?

Teach with Your Strengths is a
book written by educators who have devoted their lifetime to applying this
simple philosophy into their own behaviors in the classroom.3 This book demonstrates the use of personal
strengths to facilitate leadership in the classroom in order to avoid
mediocrity. Although many educators who
follow this philosophy, not nearly enough do.
And if we are to encourage our students towards the application of their
strengths, let us first lead by example.
Are you thinking social learning theory?
I am.

Let me
leave you with this final thought:

“Most
people think they know what they are good at. They are usually wrong… and yet,
a person can perform only from strength.” – Peter Drucker

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